Imaging pathway for Primary Care direct access to CT chest/abdomen/pelvis for suspected malignancy (Guidelines)

Warning

Referral Criteria

Clinical assessment of patient by GP leads to very strong suspicion of suspected underlying malignancy with, for example, unexplained significant weight loss of >10% body weight.

There is no indication of localising signs, symptoms or laboratory tests to suggest malignancy in a specific system. If there is any indication of localising signs, symptoms or laboratory tests to suggest malignancy in a specific system then direct referral to secondary care should be made using the appropriate established pathway without requesting a CT scan

This pathway is for patient who are 40yrs of age or over, except where metastatic disease has been reported on Chest x-ray (CXR) or ultrasound.

Clinical Assessment

A GP should have completed the following elements:      

  1. Full systems examination including depression screening.
  2. Relevant biochemical and haematological testing, if not done within the last 3 months – FBC, PV, Renal function including eGFR, HbA1c, LFTs, TFTs and myeloma screen
  3. CXR
  4. Consider the principles of realistic medicine

Other Radiological Assessment

  1. No CT of chest/abdomen/pelvis in last 12 months
  2. Patient is 40yrs of age or over. An Ultrasound of abdomen and pelvis can be requested if the patient meets referral criteria but is under 40.
  3. If a CXR has been reported as showing metastatic disease with no known primary do not request CT.  Please refer to respiratory as USC.  
  4. If a CXR has been reported as showing metastatic disease and the patient has had an invasive malignancy in the previous 5 years please discuss with that team.
  5.  This pathway is not for patients where there is evidence of primary intrapulmonary malignancy on CXR. If a CXR has been reported as a likely primary lung malignancy please refer to respiratory as USC.
  6. If an ultrasound has been reported as showing likely liver metastases then this CT pathway can also be used for all age groups

Notes

DNA – referring practice will be notified. New referral required if still wanted, after discussion with the patient to ensure adherence.

Target will be to book CTs (and USs) within 2 weeks, and for CT, report within 1 to 2 weeks.

Any unexpected urgent findings will be notified to the practice within 1 working day by email or telephone. Life threatening findings will be communicated more urgently.

FAQ for GP CT Referral for Cancer Pathway

Click here for FAQ

Abbreviations

Abbreviation Meaning
CT Computerised tomography
CXR Chest X-ray
eGFR Estimated Glomerular Filtration Rate
HbA1c Haemoglobin A1c
FBC Full blood count
LFT Liver function test
TFT Thyroid function test

Last reviewed: 09/06/2023

Next review date: 30/06/2026

Author(s): Cancer Services Directorate .

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Nick Abbott, Board Clinical Cancer Lead, Dr Sian Jones, Board Primary Care Lead for Cancer .

Document Id: TAM485

Internal URL: https://nhshighlands.azurewebsites.net/umbraco/#/content/content/edit/11296